The incremental validity of primacy as a predictor of everyday functioning.

Abstract

Objective: Verbal memory is a predictor of later functional deficits. However, it is unclear if a specific aspect of immediate free-recall is driving this relationship. Serial position effects (i.e., relationship between a word’s placement on a word-list and its likelihood of being recalled) have been shown to predict conversion from mild cognitive impairment (MCI) to Alzheimer’s disease (AD). The goal of this study was to determine if serial position effects predict functioning 10-year postbaseline when controlling for demographic variables and total cognitive scores. Method: Data from 2,802 participants in the Advanced Cognitive Training for Independent and Vital Elderly trial were examined to predict subjective (i.e., Minimum Data Set Home Care questionnaire subscales) and performance-based (i.e., Observed Tasks of Daily Living and Everyday Problems Test) functioning 10-year postbaseline. Multilevel modeling was used to examine the association between functioning 10-year postbaseline and scores at baseline. Results: Primacy performance demonstrated the most consistent associations with overall subjective and performance-based functioning measures 10-year postbaseline. Specifically, higher primacy performance was associated with less decline in subjective and performance-based functioning over time, particularly when primacy was analyzed from the Rey Auditory Verbal Learning Test. Fewer associations were found between middle and recency scores with subjective and performance-based functioning measures. Conclusion: The present study suggests that serial position effects predict future subjective and performance-based functional changes, beyond demographic information and global cognition. The study adds to a growing literature about the relative importance of primacy, especially in the prediction of functional changes.

Longitudinal change in serial position scores in older adults with entorhinal and hippocampal neuropathologies

“…The finding of selective primacy score decline complements existing literature that indicates alterations in serial position effects, mostly primacy performance, can predict future decline in global cognitive functioning among older adults who are considered cognitively normal (Bruno et al, 2013, 2016), those with MCI (Egli et al, 2015), and those with probable AD (Marra et al, 2000). Reduced primacy performance has also been linked with subsequent decline in subjective and performance-based functional measures of daily living in older adults without dementia (Weitzner et al, 2021), providing convergent evidence for the utility of primacy performance in predicting clinically relevant functional changes. Importantly, the primacy score appears to be uniquely suited to differentiating early stage (i.e., MCI (Cunha et al, 2012) or at-risk for AD (La Rue et al, 2008)) groups compared to healthy controls.…”

Baseline Differences in Driving Frequency as a Predictor of Cognitive Decline and Alzheimer’s Disease

“…Although much research has focused on cognitive functioning as a predictor of everyday functioning (including driving) in older adults, [1][2][3][4] increasing evidence suggests there may be utility in measuring everyday functioning as a predictor of cognitive decline and dementia. One longitudinal study found that reported early limitations in everyday functioning especially in instrumental activities of daily living (IADLs) (eg, medication and financial management) was significantly associated with cognitive decline and conversion from normal cognitive ability to MCI.…”